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HomeMy WebLinkAbout2024-00066401 ILLINOIS TRAFFIC CRASH REPORT Sheet 1 of 4 Sheets II II I III OIH III 1001101111 NHHIH IIHIHHIIHUHIl HAII DRAG TRFD TRFC WEAT DRVA VIS VEND LGHT COLL MANY n03593628 u, 1 U21 2 4 1 U1 2 U2 1 U, 1 U2 1 U1 1 U2 1 1 15 Ut 1 U2 1 *P 0119* INVESTIGATING AGENCY DAMAGE TO ANY 0$500 OR LESS TYPE OF REPORT 0 A No Injury J Drive Away AGENCY CRASH REPORT NO. TRFW Elgin Police Department ONE PERSON'S ❑$501-$1.500 ®ON SCENE 1 0 NOT ON VEHICLE/PROPERTY ®OVER$1.500 ❑AMENDEDCENE(DESK REPORT) l$l B Injury and JorTow Due To Crash YR 2024I2024-00066401 VEHT * ADDRESS NO. HIGHWAY or STREET NAME CITY TOWNSHIP INTERSECTION DATE OF CRASH TIME SECONDARY CRASH 1 17 LARKIN AVE ® ❑ Elgin RELATED ®Y ❑N 10 17 2024 02:30 ❑AM ® ❑YES NO u1 ,•< PRIVATE mo /day/yr ®PM FLOW CONDITION m FT/MI N E S W N MELROSE ) Kane HIT&RUN ❑Y CZN PEDALCYCUST®N ® FREE FLOW # LNS 0 I&DRIVER ❑ PARKED ❑DRIVERLESS ❑ PEE) O PEDAL ❑EOUES ❑NIA/ ❑NCV 0 Dv DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) Y N 0 0 0 5 / 0 2 /1 9 7 4 FOR DAMAGEDAREA(S) IsCNT TOWED U1 NAME(LAST,FIRST,M) . Ma Delosangeles mo day yr Toyota Corolla 2010 00-NONE 11 .i�. D DUE TO CRASH ® ❑ 13-UNDERCARRIAGE FIRE ❑ 21 SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) 10 O DISTRACTED 0 ® U2 0 m 518 S ALFRED AVE F / THER ❑Y IN NSYSTE DUNK VEH. nM IN AT CRASH ENGAGED 0 99-UNKNOWN 89 16 TOP® 'Distraction Value ALGN = r CITY PLATE NO. STATE YEAR POINT OF {I 6 i+O COM VEH 0 ® 1 (7 FIRST CONTACT 1 7__, _�,5 •If Yes,See Sidebar 111 0 Z 2T1BU4EE1AC482123 STATE FARM ❑Y ®N U2 m in EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER RSUR m a 99 9 FLORES, BALTAZAR 1951948-SFP-13 1 o HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY,STATE,ZIP PHONE NUMBER r L RESPONDER 518 S ALFRED AVE. ELGIN - IL.60123 (847)284-5357 VEHU 73 5 ®DRIVER 0 PARKED 0 DRNERLESS 0 PED ❑PEDAL ❑EQUES 0 NW ❑NCV 0 DV DATE OF BIRTH MAKE MODEL YEAR CIRCLE NUMBER(S) U1 2 m m / J FOR DAMAGED AREA(S) f12C IT TOWED Y N s Ferreira. Murillo,J. 0 4 0 3 1 9 8 4 Honda Accord 2010 00-NONE O' i'O DUE TO CRASH 0 2 xi NAME(LAST,FIRST,MI mo day yr I© UNDER CARRIAGE 10 i All �Z/FIRE ❑ ® U2 C c STREET ADDRESS SEX SAFT AIR AUTOMATION LEVEL LEVEL 14-TOTAL(ALL) DISTRACTED 0 IN SPDR C) SYSTEM IN 0 ENGAGED 0 15-OTHER 9 16-TOP 3 X a` 503 BARRINGTON AVE M ❑Y ® N DUNK VEH. AT CRASH 99-UNKNOWN •Distraction Value 0 N CITY STATE ZIP INJ EJCT EPTH PLATE NO. STATE YEAR POINT OF 8 it 6 :I 4 COM VEH ❑ ® U1 FIRST CONTACT 12 7.r 5 Irves,See Sidebar to EAST DUNDEE IL 60118 B EC97724 IL 2024 0 0 D TELEPHONE DRIVER'S LICENSE NO. STATE CLASS CDL ID VIN INSURANCE CO. EXPIRED U2 0 (331)223-5599 F665-4208-4096 IL D 0 1 HGCS1 B32AA017500 STATE FARM ❑Y ®N RDEF EMS AGENCY PEDV PPA PPL VEHICLE OWNER(LAST,FIRST.M) POLICY NUMBER 1 I 99 9 MARTIEZ CARDOSO.ANA 1410150-SFP-13 BAG 3 HOSPITAL(TAKEN TO) INCIDENT IF'Y' OWNER STREET.CITY.STATE.ZIP PHONE NUMBER 996 < RESPONDER POONR 503 BARRINGTON AVE. EAST DUNDEE. IL.60118 U1 = (UNIT) I SEAT) (DOB! (SEX) i)SAFT) (AIR) (INJI (EJCTI (EPTH) PASSENGERS&WITNESS ONLY (NAME!+(ADDRESS)(ITELEPHONEI i EMS) (HOSPITAL) 1 4 02 /27/2015 F 2 4 B 1 0 ANGELES FLORES/518 S ALFRED AVE-ELGIN,IL,60123 (847)284 5357 Elgin Fire Sherman U2 996 m 2 6 01 /1 4/2019 M 2 3 B 1 0 GAEL FLORES/518 S ALFRED AVE.ELGIN.IL-60123 Elgin Fire Sherman #OCCS D (847)284 5357 g X / / Ut 2 m / / 2 0 EV MOST EVNT LOC DAMAGED PROPERTY OWNER NAME DAMAGED PROPERTY POLICE NOTIFIED TIME ❑AM Did crash occur ❑Y U2 Z N ® 11 4 10/17 /2024 02 30 0 pM in a Work Zone? ®N DIRP D 1 r PRIMARY CAUSE SECONDARY CAUSE EMS NOTIFIED TIME It YES check one below: T PROPERTY OWNERS ADDRESS:STREET.CITY,STATE,ZIP 0 AM Ut 5 ., 2 0 2 28 10,17 /2024 02 31 co PM ❑Construction * N 3 0 ®CITATIONS ISSUED 0 PENDING SECTION CITATION NO. EMS ARRIVED TIME 3 0 AM ❑Maintenance U2 Q ARREST NAME Escutia-Guzman. Ma Delosangeles 11-901-A s218000895 10,17/2024 02 37 Izi PM SLMT 1 ® 11 4 ❑Utility p U CITATIONS ISSUEDPENDING ROAD CLEARANCE TIME o N ❑ 0 SECTION CITATION NO. AM 30 2 0 ARREST NAME 10/1 7 /2024 03 41 ®PM ❑Unknown work zone type U1 T 2 2 3 0 OFFICER ID SIGNATURE BEAT/DIST. SUPERVISOR ID. COURT DATE TIME ®AM Workers present? El 30 218-Wilson.Greg 601 - 11 , 12/2024 01 30 p PM ®N U2 REMEMBER TO USE BLACK INK,PRESS HARD,PRINT LEGIBLY AND COMPLETE ALL REQUIRED FIELDS! A Diagram and Narrative are required on all Type B crashes, LARGE TRUCK, BUS, OR HM VEHICLE even if units have been moved prior to officer's arrival. IF MORE THAN ONE CMV IS INVOLVED,USE SR 1050A ADDITIONAL UNITS FORMS ' } A CMV is defined as any motor vehicle used to transport passengers or property and. Z 1 Has a weight rating more than 10,000 pounds(example truck or truck/trailer ' r i ; i r r , , i i i i i combination).or —I INDICATE NORTH XI BY ARROW 2 Is used or designed to transport more than 15 passengers including the driver C I ', ! i. , ' ' 1 ', ' f ` r r r (example'.shuttle or charter bus)-or n S ; I I ; 3. Is designed to carry 15 or fewer passengers and operated by a contract carrier 0 i------'-----• + + • : ' ' 1 1 1 i } - i• transporting employees in the course of their employment(example.employee 71 transporter-usually a van type vehicle or passenger car).or 03 ' r i• 4 Is used or designated to transport between 9 and 15 passengers,including the driver, 9 Po P 9 N for direct compensation(example:large van used for specific purpose).or O i i 5 Is any vehicle used to transport any hazardous material(HAZMAT)that requires placarding(example placards will be displayed on the vehicle) 11 CARRIER NAME Z ' t ADDRESS 0 N • CITY/STATE/ZIP MOTOR CARR ID ❑ Interstate ❑ Intrastate ❑ Not in Comm./Govt. ElNot m Comm./Other Q C r---- ----, r r r r r - DO ILCC NO. m U N XI , Source of above Z IDOT PERMIT NO WIDELOAD? ❑Yes ❑No = ' TRAILER VIN 1 m to LOCAL USE ONLY TRAILER VIN 2 m TRAILER WIDTH(S) 0-96'1 97-102'1 >102 m T TRAILER 1 ❑ ❑ ❑ Z TRAILER 2 ❑ ❑ ❑ o U 1 COLOR U 2 COLOR TRAILER LENGTH(S)1 ft 2 ft. Z Gray White u 1 TOWED - TOTAL VEHICLE LENGTH ft. NO.OF AXLES DUE EDTO ❑X DISABLING DAMAGE ❑ NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO Redmons I Impound Lot Garage SELECT CODES FROM THE BACK OF CRASH BOOKLET u 2 TOWED X DISABLING DAMAGE NOT DISABLING DAMAGE DAMAGE EXTENT- 3 TOWED BY/TO: DUE TO ❑ Redmons I Impound Lot Garage VEHICLE CONFIG _ CARGO BODY TYPE LOAD TYPE